Facet Joint Arthropathy

Facet Joint Pain

John Miller Physiotherapist

Article by John Miller

Facet Joint Arthropathy

What is Facet Joint Arthropathy?

Facet joint arthropathy is also commonly referred to as facet joint syndrome, facet joint pain, facet joint sprain, but mostly it is a pain caused by a facet joint injury. Facet joints are synovial joints between the vertebrae of your spine. Biomechanically, the function of each pair of facet joints is to guide and limit the movement of that spinal motion segment.

You may also hear facet joint arthropathy described as a zygapophyseal joint syndrome. Your facet joints are also known as zygapophyseal, apophyseal, or Z-joints.

Each section of your spine has facet joints. You may hear them referred to as your cervical facet joint pain (neck), thoracic facet joint pain (mid-back) and lumbar facet joint pain (low back). There are two facet joints (left and right) in each spinal motion segment. Facet joint arthropathy is one of the most common causes of neck pain, back pain and thoracic spine pain.

What Causes Facet Joint Arthropathy?

Facet joint motion can be disturbed by injury. Joint action can stiffen – known as hypomobility. Alternatively, joint movement can become excessive – known as hypermobility. All of these fall within the category of a facet joint arthropathy.

What Causes Facet Joint Hypomobility?

Facet joint hypomobility can be caused by:

  • locked facet joint,
  • facet joint arthritis,
  • degenerative facet joint osteophytes (bone spurs),
  • joint capsule scarring, thickening or shortening, or
  • protective muscle spasm.

In other words, a facet joint can stiffen due to a slow degeneration or due to uncontrolled motion, which is where your local muscle strength is vital to stabilise and control your facet joints.

What Causes Facet Joint Hypermobility?

Hypermobility is typically traumatic or repeated microtrauma in origin. Traumas may include:

  • fracture,
  • dislocation,
  • overstretched ligaments, or
  • a disease that destroys the joints, e.g. Rheumatoid arthritis.

What Causes a Locked Facet Joint?

Simple movements such as a mild twist, awkward movement, or just doing something your body didn’t expect (such as tripping) can lock a facet joint. In most cases, this is due to your facet joints motion exceeding your muscle control.

If you have previously suffered an injury or you have local muscle weakness supporting your facet joints, then it is even easier to repeated lock a facet joint.

What are the Symptoms of a Locked Facet Joint?

Pain is one of the first symptoms a patient will notice with a facet joint injury. A neck facet joint will cause neck pain and potentially shoulder or upper arm pain. Acute cervical facet joint lock can result in an acute wry neck. A back facet joint injury will cause low back pain and potentially pain referred to your buttock or thigh.

When a facet joint locks, you may not be able to move in the direction away from where it’s locked. For example, if the joint is locked in a flexed forward position, you will probably have difficulty arching backwards. The opposite also occurs. In acute phases, muscle spasm will attempt to protect the injured facet joint.

The initial injury can sometimes occur days or occasionally weeks earlier. Your body will attempt to compensate for the locked joint by the neighbouring joints moving more than they usually would. This abnormal movement can often cause pain on the opposite side to the locked facet joint and may potentially lead to other conditions such as sciatica or arm pain. Most commonly, you will notice decreased movement and pain or difficulty stretching.

People who have this problem recurrently are said to have facet joint syndrome. The most common cause of facet joint syndrome is weak stability muscles that are failing to control the movement of your spine.

How is a Facet Joint Arthropathy Diagnosed?

A hands-on examination from a skilled physiotherapist can diagnose facet joint arthropathy.

Using their professional palpation skills, they will confirm the specific facet joint arthropathy and whether it is locked, stiff or unstable. Xrays, MRI’s and CT scan are used to identify arthritic changes and fractures but are unable to detect a locked facet joint. Degenerative changes within the facet joints are commonly called spondylosis.

Please consult your physiotherapist for specific advice regarding your facet joint arthropathy management.

More information

Facet Joint Arthropathy Treatment

Specific treatment will vary depending upon your particular facet joint arthropathy. The procedure for a locked facet joint is relatively simple. Your physiotherapist will quickly detect which facet joint is locked. Then proceed to unlock it. Usually, a locked facet can unlock using a painless joint release technique.

The next step is to regain full motion and commence strengthening or other exercises to prevent a future, recurrence. Everyone is slightly different, so your treatment will vary depending on what deficits your physiotherapist has found during your examination.

Unstable Facet Joint Treatment

Unstable or hypermobile facet joints need to be treated entirely differently to a locked facet joint. The fact that the joint already moves excessively would suggest that further joint loosening is unlikely to assist a hypermobile facet joint.

These patients respond better to muscle control and stabilisation program. You physiotherapist will guide you.

Please check with your physiotherapist or doctor for their professional opinion.

Facet Joint Arthropathy Treatment Results?

Physiotherapy will provide the majority of facet joint arthropathy patients with complete relief. (Hu et al. 2006). Locked facet joints will usually start improving immediately post-unlocking. How they progress beyond that, depend on what other concomitant factors are present. How long has the joint been locked? What caused the locking? What adjacent joint motion there is available?

Based on your physiotherapist’s examination, they will be able to provide you with more strict guidelines. Facet joint instability will take longer to rehabilitate since they require time and practice for your muscle strengthening to occur. Once again, please check with your treating physiotherapist for their professional opinion and treatment plan.

Other Treatment Options

Massage

Massage can be an excellent form of muscle spasm relief to allow your facet joint spasm to release.

Acupuncture

Localised acupuncture or dry needling techniques can provide localised muscle spasm and facet pain relief. Ask your physiotherapist for more advice.

Facet Joint Injections

Facet joint injections m confirm a diagnosis and provide short-term (a week or two) relief. Researchers have found that facet joint injections are less effective than patients who exercise in the long-term. (Mayer et al. 2004)

Radiofrequency

Radiofrequency may assist chronic cases which do not respond to physiotherapy treatment. Radiofrequency cauterises the nerve, providing pain relief for a while. The downside is that the pain returns typically when the nerve regrows within a few months.

Summary

Every case of facet joint arthropathy is different. Please check with your physiotherapist for their professional opinion.

What Causes Lower Back Pain?

Introduction

Lower back pain is a widespread issue in Australia, stemming from diverse conditions. As physiotherapists, we often encounter various causes of this pain. This guide aims to shed light on these causes and provide valuable insights for effective management.

Lower Back Pain Causes
What's Causing Your Lower Back Pain?

Muscle-Related Injuries

Muscle injuries are a predominant cause of lower back pain, including:

Recent research underscores the importance of regular exercise and core strengthening in preventing these injuries.

Bone-Related Injuries

Bone health is crucial in lower back pain, encompassing conditions like:

Disc-Related Injuries

Spinal discs are vital for spinal health:

Minimally invasive surgical techniques have transformed the treatment of severe disc-related injuries where physiotherapy and other non-operative options fail to improve.

Back Joint Injuries

Nerve-Related Injuries

Nerve issues can lead to:

Physiotherapy and newer medications have been effective in managing these conditions. Some will require injection therapies or surgery.

Pelvis-Related Injuries

Pelvic issues also contribute to lower back pain:

Pregnancy-Related Pain

  • Pregnancy Back Pain: Often due to increased back strain during pregnancy. Prenatal physiotherapy programs are beneficial.

Systemic Diseases

Systemic diseases like Ankylosing Spondylitis, Fibromyalgia and Rheumatoid Arthritis can cause back pain.

Recent Research and Advancements

Current research emphasises a holistic approach to treating lower back pain. Techniques like yoga and Pilates, alongside traditional physiotherapy, and conservatively progressed gym programs show significant relief. The role of diet in managing weight and inflammation is increasingly recognised.

Best Treatments for Lower Back Pain

Treatment varies but often includes:

  • Physiotherapy
  • Pain management
  • Strength and flexibility exercise programs
  • Ergonomic adjustments
  • Surgical interventions for severe cases

Conclusion

Lower back pain is a significant health concern in Australia. Understanding its causes and seeking professional physiotherapy advice can greatly improve life quality. Remember, early intervention is key for an effective recovery.

What to Do?

If you're experiencing lower back pain, it's vital to consult a physiotherapist or doctor. They can provide an assessment and customised treatment plan based on your specific condition.

Back Pain FAQs & Products

Your Comprehensive Guide to FAQs, Causes, and Relief

Experiencing back pain and looking for answers? Our comprehensive FAQ section covers everything you need to know about back pain - from common causes and symptoms to effective treatments.

Click the links to our detailed articles to understand better and manage your back pain. Explore links to related topics like 'Severe Back Pain Management', 'Posture Improvement Techniques', and 'Physiotherapy for Chronic Back Issues' for a holistic approach to your spinal health."

back pain faqs
Back Pain Faqs

What Causes Back Pain?

Discover the various factors behind back pain, including muscle strains, herniated discs, and more.

How Can I Relieve Back Pain?

Explore treatments ranging from physiotherapy to exercises, tailored to alleviate back pain.

Can Back Pain Be Prevented?

Learn how to prevent back pain through healthy habits and proper body mechanics.

When Should You See a Physio or Doctor for Back Pain?

Understand when it's crucial to seek professional medical advice for back pain.

Repeated Bouts & Incidental Back Pain FAQs

Addressing frequently occurring and sudden back pain incidents.

Youth Back Pain FAQs

Focusing on the prevention and management of back pain in teenagers.

Back Pain Exercises FAQs

Discover effective exercises and tools for back pain relief.

Back Pain Prevention FAQs

Key insights into everyday activities and their impact on back health.

Posture FAQs

Learn about the importance of good posture and techniques to improve it.

Other Treatments For Back Pain?

Investigate a variety of treatments, from nerve blocks to spinal cord stimulation.

Conclusion

Empowering you with knowledge to understand, address, and prevent back pain effectively.

What to Do Next

Now that you've gained insight into the causes and remedies of back pain, it's time to take the next steps. Start by applying the prevention techniques and exercises detailed in this guide to your daily routine. If you're currently experiencing back pain, consider the treatment options discussed and consult a healthcare professional for personalised advice. Remember, every journey to back health is unique.

Stay informed, be proactive in your self-care, and don't hesitate to seek professional help when needed. For further reading, explore the hyperlinked articles to deepen your understanding and support your path to a pain-free life. Here’s to taking control of your back health and embracing a more comfortable, active lifestyle.

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